Characterizing risk factors for new neurological deficits in children undergoing posterior spinal fusion for idiopathic scoliosis.

BACKGROUND: Neurological complications following posterior spinal fusion for idiopathic scoliosis are rare but potentially devastating, with outcomes ranging from temporary weakness to permanent disability. While most neurological injuries are thought to result from intraoperative events, it remains unclear whether preoperative or perioperative factors also influence risk. Identifying such predictors could help identify at-risk patients and guide preventative strategies.

METHODS: We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) database from 2016 to 2023. Patients under 18 years undergoing elective posterior spinal fusion for idiopathic scoliosis were included. The primary outcome was new postoperative neurological deficit within 30 days. Univariate and multivariable logistic regression analyses were performed to identify independent predictors. Baseline characteristics were also compared between peripheral nerve and spinal cord injury subtypes.

RESULTS: Of 7779 patients, 64 (0.82%) developed new neurological deficits. Most were peripheral nerve injuries (n = 31), followed by spinal cord injuries (n = 14). Multivariable analysis identified seven independent predictors: preoperative steroid use (OR 12.357, 95% CI 2.63-58.076), lower albumin levels (OR 2.574, 95% CI 1.49-4.441), prolonged prothrombin time (OR 1.148, 95% CI 1.04-1.271), elevated platelet count (OR 1.004, 95% CI 1.00-1.007), longer operating room duration (OR 0.985, 95% CI 0.97-0.998), absence of antifibrinolytic use (OR 0.432, 95% CI 0.20-0.932), and greater postoperative transfusion volumes (OR 1.002, 95% CI 1.00-1.003). Subtype analysis revealed distinct profiles, with spinal cord injuries associated with lower hematocrit, greater transfusion volumes, and more spinal levels fused compared to peripheral nerve injuries.

CONCLUSION: Several preoperative laboratory markers and perioperative factors, such as low preoperative albumin and higher prothrombin time, were associated with increased risk of neurological complications after pediatric scoliosis surgery. While these associations do not establish causality, they may help identify patients at heightened risk and warrant further investigation.